Thanks for your thoughts. Your criticism warrants a detailed response.
First, the NNT has been calculated based on those in primary prevention who received the prescription and took it (please refer to reference 6 in my post.) “Primary prevention” refers to the prevention of first CVD events in apparently healthy people whose biomarkers of risk have been defined by consensus statement to confer an elevated risk. This selection of risk thresholds is an arbitrary one, not one dictated by physiology.
Lowering those risk thresholds even further will further inflate the NNT.
Second, your remark: “trying to convince people that they shouldn’t trust statin studies because they were funded by pharmaceutical companies is not serious”
Contrary to what you believe, the issue is serious. Very serious.
I refer you to some of the large amount of studies that have investigated this issue:
“Drug trials financed by the pharmaceutical industry yield results favorable to the funding company much more often than studies with other sources of support” [1]. In fact, 4-times more often [2].
It is, however, not only at the level of the published trial itself that industry manipulates the data. Up to 50% of industry-funded trials that yielded null-results are not being published. The selection of authors and investigators is heavily influenced by the industry. Add to this the industry’s direct influence on healthcare providers (north of 3 billion US$ in 2022 alone). Thanks to the Sunshine Act these payments are made visible to everyone. Just follow this link:
https://openpaymentsdata.cms.gov/
As a consequence, Stamatakis et al. came to the conclusion:
“Currently, industry expenditure influences and determines medical practice and attitudes at various levels at the expense of patients’ health, healthcare budgets and medicine’s integrity” [2]
Third: “drug study parameters are published in detail and open to scrutiny and criticism”. That would be nice, but the reality contradicts your assertion.
“Most trials (478 trials [79.7%]) provided a data availability statement, and most indicated intention to share the data, but only 16 trials (2.7%) had data already readily available to others.”
[3]
Fourth, your accusation that I am “more interested in building a following among the anti-statin, anti-drug, anti-Pharma believers than in providing a public service” is a personal attack which I won’t dignify with a response as your accusation is baseless and contrary to my professional ethics.
References
[1] Schott G, Pachl H, Limbach U, Gundert-Remy U, Lieb K, Ludwig WD. The Financing of Drug Trials by Pharmaceutical Companies and Its Consequences. Dtsch Arztebl 2010;107:295–301. doi:10.3238/arztebl.2010.0295.
[2] Stamatakis E, Weiler R, Ioannidis JPA. Undue industry influences that distort healthcare research, strategy, expenditure and practice: A review. Eur J Clin Invest 2013;43:469–75. doi:10.1111/eci.12074.
[3] Siena LM, Papamanolis L, Siebert MJ, Bellomo RK, Ioannidis JPA. Industry Involvement and Transparency in the Most Cited Clinical Trials, 2019-2022. JAMA Netw Open 2023;6:E2343425. doi:10.1001/jamanetworkopen.2023.43425.
